Fistula matters

[Rerun]

I saw the Vascular Surgeon today.  They "fit" me in.  Told me to be there at 4:15.  I finally saw him at 5:30.  Damn!  I fell for it again!  Call me Charlie Brown!   

Anyway, I get to have a fistula-gram next week.  He thinks I've got a narrowing going on.  Oh JOY!   

[kitkatz]

Oh nuts!  I hate for anyone to have access problems.

Katherine

[Black]

I saw the Vascular Surgeon today.  They "fit" me in.  Told me to be there at 4:15.  I finally saw him at 5:30.  Damn!  I fell for it again!  Call me Charlie Brown!   

Anyway, I get to have a fistula-gram next week.  He thinks I've got a narrowing going on.  Oh JOY!   

  Charlie Brown   yep, we've all been there.

IF the narrowing is above or below the fistula or buttonhole, can they put in a stent like they do for cardiac patients?  Or do that "roto-rooter" type thingy?

[Naggy6]

My sympathies to any of you who have had access problems. I have seen lots of them in my unit but I myself have been very fortunate as to not have had any problems with mine.

I hope to have nxstage soon though and was worried about getting stuck every day and what it would do to my fistula so I decided to try the button hole again. I think it's actually going pretty good. I do still use lidocaine though. I know a lot of patients that say why get 4 sticks when you can get only two but for some reason I don't feel the lidocaine. Those 15g needles sure don't do any thing for me though I feel it the whole time if I don't use the lidocaine.

The tech says it's all in my head    but you know what I say, doesn't make any dif. if it's all in my head it still hurts.

[Bear]

 Ah...interesting. I can be O.K. for a full week (4-sessions) or even 2.
 By then I have stopped the 'caine (it stings, I find) and just gone to putting the
 blunts straight in. Great 
 BUT...then I'll have trouble cannulating and a couple of attempted digs will make
 my arm sore & I'll be reaching for the little 'caine syringe (it's part of my 'going on' kit,
 so I always load it up ready). I find I'll then need to use it (psychosomatically or otherwise)
 for the next few sessions. But _it_ can swell the entry area & cause cannulation
 problems itself! So then I'll stop it again.   
 Repeat cycle     

[fireguy]

Just got back from a fistula gram. Had some narrowing, they ballooned it three times,ouch,thank god for happy drugs. It helped some, flows back to normal but will have to keep a close eye on pressures for a while. I Had roto rotor back in Dec for a clotting.Not bad, ballooning worst.

[Rerun]

Fireguy...... any suggestions for me?  I do NOT like the sounds of your experience.  Happy drugs?  Did you take your own, or did they provide them. 

Did you drive yourself?  Do I need someone with me?

[Rerun]

My "routine procedure" went BAD.  When they put in the balloon and inflated it, my vein split and blood poured into my arm and breast tissue.  All I know is it felt like the JAWS of LIFE gripped my arm and was trying to squeeze blood out of it.  DAMN it hurt.   The guy was trying to stay calm........"GET ME A STINT, GET ME A STINT!!" 

I just got home from the hospital.  They kept me overnight and then dialyzed me with the same fistula.  OUCH!  But it still works thank GOD.  Anyway, I've got to go lay down.

[Black]

My "routine procedure" went BAD.  When they put in the balloon and inflated it, my vein split and blood poured into my arm and breast tissue.  All I know is it felt like the JAWS of LIFE gripped my arm and was trying to squeeze blood out of it.  DAMN it hurt.   The guy was trying to stay calm........"GET ME A STINT, GET ME A STINT!!" 

I just got home from the hospital.  They kept me overnight and then dialyzed me with the same fistula.  OUCH!  But it still works thank GOD.  Anyway, I've got to go lay down.

OMG!!!   I am so sorry.  That sounds awful, but I am so glad it still works!!   I hope they sent you home w/ something for pain and you get a good night's sleep.

Lorelle

[Epoman]

My "routine procedure" went BAD.  When they put in the balloon and inflated it, my vein split and blood poured into my arm and breast tissue.  All I know is it felt like the JAWS of LIFE gripped my arm and was trying to squeeze blood out of it.  DAMN it hurt.   The guy was trying to stay calm........"GET ME A STINT, GET ME A STINT!!" 

I just got home from the hospital.  They kept me overnight and then dialyzed me with the same fistula.  OUCH!  But it still works thank GOD.  Anyway, I've got to go lay down.

Oh man I'm sorry that happened to you Rerun, I hope you feel better soon. I live in constant fear about something happening to my fistula. I even have nightmares sometimes.

- Epoman

[susie q]

OMG.. Rerun, I am so sorry this happened to you.. scary stuff..
They are hoping to start using my new fistula in a couple of weeks..  it's not visible but an ultrasound measured the vein at almost .5mm..  I'm scared..

[kevno]

Sorry to hear about fistula again. You have not had much luck with it up to now. But it will get better I am sure. I  see they have still used the fistula for dialysis. At least you are using your fistula, I have not let the nurses use mine in over a month now.

Keep chin up

Kevno

[onesicpup]

Ok it's been a couple of days since I last posted, I went last week to my neph and this Wednesday I finally get my vein mapping done. The following Thursday I  go for a renalgran, whatever the heck that is and then on June 1st I finally talk to the surgeon about my kidney removal and subsequent dialysis.  My kidneys are both large 27-28 cm each and am now about 15%GFR. Any feedback would be appreciated

[charee]

Hi I just had my first appointment with a vascular surgeon now i am off for a mapping ultsound of my arm. After reading some posts iam getting abit nervous about it all as i have a needle phobia but i guess that is something i will have to try and get over not much choice is there ? Well thanks  again for all the great info

Cheers

Charee

[Black]

Hi I just had my first appointment with a vascular surgeon now i am off for a mapping ultsound of my arm. After reading some posts I am getting a bit nervous about it all as i have a needle phobia but i guess that is something i will have to try and get over not much choice is there ? Well thanks  again for all the great info

Cheers

Charee

Be sure to have a good talk w/ your surgeon BEFORE the surgery about using your non-dominant arm.  Having to learn to do everything w/ your other hand, because your dominant arm has the fistula and needles, is an aggravation you can do w/o.  After hearing about some surgeons using the dominant arm, because the veins were larger and easier to use, my husband refused to let the tech map his dominant arm.   That was probably a little extreme but he was VERY nervous.    His fistula appears to be fine. The scar from where the surgeon went in is already gone.  BTW, he had so little pain that he didn't need the pain med the Doc prescribed -- only took two Tylenol.  Hope yours goes as well.

Lorelle
PS: Be sure you are exercising your arm (Hubby squeezes a small rubber ball) so the veins will get larger and get better blood flow.

[kevno]

I have never had a choice of which arm one big (well in the 70's we called them shunts, now fistula) Vein taken out of leg put in left arm. Called a Venus loop fistula. 1980 the nice wrist fistula in the right arm only 5 stitches. 2000 that fistula stopped. 2001 the surgeon had a go at restarting it. He had to unblock the vein from my wrist to the top of my forearm. 44 Staples. After all that all I have is a two inch stretch which one needle can be put in. That is if I am in the mood to let a nurse have a go. Most of the time the lines in my neck are used.

[scyankee]

How does one learn to stick themselves?  I have such a bad phobia with needles that I can't look
at them before and after dialysis.  Having very small veins and not having my fistula developing it
might be better if I could possibly learn to do it myself.  I'd appreciate any tips.

[Epoman]

How does one learn to stick themselves?  I have such a bad phobia with needles that I can't look
at them before and after dialysis.  Having very small veins and not having my fistula developing it
might be better if I could possibly learn to do it myself.  I'd appreciate any tips.

Give it time, once your vein is a little biggrer, I mean it's clearly visable above the skin. Give it a try, I promise you won't let anyone else EVER stick you again. Then maybe try the buttonhole technique, and I promise you will feel no pain what so ever. You need to get over your fear, just hold the needle and get used to it. I promise it is very easy.

[BigSky]

How does one learn to stick themselves?  I have such a bad phobia with needles that I can't look
at them before and after dialysis.  Having very small veins and not having my fistula developing it
might be better if I could possibly learn to do it myself.  I'd appreciate any tips.

The unit should be able to teach you.  Also there are videos the unit should have on buttonholes and one that teaches how to stick yourself.

[angieskidney]

My unit says they can't teach me unless I go to another shift .. but it took them over a week just to leave the note for the head nurse so she knows I want to do this. But it looks like it will be awhile since my fistula blew this week. I was like "umm.. is that bad? My arm is getting really big really fast!" and the nurse had to take the 15 gauge needle back out and use my catheter again

Man ... problem after problem after problem with me And the surgeon said I would have no problems and don't even have to use the ball... good thing I listened to D&T City and now IHD (here)!!! I have learned the hard way .. do what other patients do ... not with the nurses or surgeons and doctors say you don't NEED to do! If it will help then WHY NOT DO IT!!?!?!? I don't know why all the medical staff are so laidback about things ...

Get all the advice you can from other patients!! They know experience and the doctors and nurses don't live your life every day where as all patients live their lives every day!!

[BigSky]

My unit says they can't teach me unless I go to another shift .. but it took them over a week just to leave the note for the head nurse so she knows I want to do this. But it looks like it will be awhile since my fistula blew this week. I was like "umm.. is that bad? My arm is getting really big really fast!" and the nurse had to take the 15 gauge needle back out and use my catheter again

Personally there isnt much to know about it.  I was ready to do it by watching the nurses do it.  However the nurses had other plans.     They had me watch a 5-10 minute video on it and one on buttonholes.  They then wanted me to have a buttonhole but I nixed that because I told them I would have no problem doing it. 

If you dont like needles a buttonhole is probably the way to go.  Myself I kinda like being stuck. 

This is not advice on  how to do it, only your unit should teach you, but from the video it told me to stick the needle in at a 45 degree angle until a flash and then to level it out and float it into the middle of the vein.  Visulizing it in your head makes it pretty easy.

[scyankee]

Thanks for the tips.  I just have to get up the nerve to try it. If I ever want to try
and travel I will need to learn this for myself because I don't trust any of the tech's
elsewhere and only 3 at my clinic!
  How long should it be before I can see my fistula bulging? My surgery was 20 months
ago and does not looked like it is growing.

[Bajanne]

A young lady in my unit does her own needles.   Maybe someday I will pick up the courage.  I have already made a small step, not using Lidocaine.

[slothluvchunk]

How does one learn to stick themselves? 

As Epoman said: there is only one way - take a needle and put it in.  I tried to psych myself up for a couple of weeks about it, and wanted to "learn" as much as I could.  In the end, after all the instruction I received from other techs - I realized there was really only one thing to keep in mind: angle.
Second point I would add is to think three dimensionally.  Apparently most dialysis techs are genetically predisposed not to do this, which is why we all have so many infiltration horror stories. 
When you put a needle in at your 25 degree angle, try to remember it has a tip on it, and that the tip is sharp.  If the back of the needle has moved 10 mm, so has the sharp end.    Picture the vein you're going into, and try to visualize where that tip is as you advance it. 

You basically just insert the needle at a 25 degree angle until you see the "flash", then level out and advance.

Stick with sharps before beginning buttonhole sites, and insist on establishing you're own buttonholes.  There should only be one person ever who sticks them, and it should be you.


My clinic did make me take a "test" on cannulation.  I reminded them that I did a brief stint as an EMT, and that they really didn't need to test my medical101 vocab, but they insisted.  I obliged of course.
 
(at this point I should mention that the tech giving me the test hadn't even heard of buttonhole when I first mentioned it in our clinic several weeks previously - suddenly DaVita decided all on its own to begin buttonholing in our clinic shortly after my original questioning - I felt as though I should be the one giving them the test.)

Fixed quotation error - Bajanne2000\Moderator

[Panda_9]

I suggest that you try not to worry yourself about it too much. Once you get used to it you will wonder what all the fuss was about. I don't even think of them as needles anymore. Using blunts takes away a lot of that fear. You will get to learn the right angle once you start cannulating. Everyones fistula is different, so every angle is going to be different. In the spots where mine is very close to the surface, I need hardly any angle at all. In the deeper parts, its more of a 45 degree angle.